Case for Diagnosis
Lobulated Lesions on the Fingers
Lesiones lobuladas en los dedos de la mano
M. Toro-Montecinos
, A. Plana-Pla, L. Barboza-Guadagnini, C. Rodriguez-Caruncho
Autor para correspondencia
Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, España
Leído
8497
Vecesse ha leído el artículo
1961
Total PDF
6536
Total HTML
Compartir estadísticas
array:24 [ "pii" => "S1578219016000184" "issn" => "15782190" "doi" => "10.1016/j.adengl.2016.01.015" "estado" => "S300" "fechaPublicacion" => "2016-04-01" "aid" => "1252" "copyright" => "AEDV" "copyrightAnyo" => "2015" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2016;107:245-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 902 "formatos" => array:3 [ "EPUB" => 45 "HTML" => 552 "PDF" => 305 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731015003890" "issn" => "00017310" "doi" => "10.1016/j.ad.2015.02.018" "estado" => "S300" "fechaPublicacion" => "2016-04-01" "aid" => "1252" "copyright" => "Elsevier España, S.L.U. y AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2016;107:245-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 207 "formatos" => array:3 [ "EPUB" => 3 "HTML" => 125 "PDF" => 79 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Casos para el diagnóstico</span>" "titulo" => "Lesiones lobuladas en los dedos de la mano" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "245" "paginaFinal" => "246" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Lobulated Lesions on the Fingers" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 500 "Ancho" => 707 "Tamanyo" => 65132 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Toro-Montecinos, A. Plana-Pla, L. Barboza-Guadagnini, C. Rodriguez-Caruncho" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Toro-Montecinos" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Plana-Pla" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Barboza-Guadagnini" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Rodriguez-Caruncho" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219016000184" "doi" => "10.1016/j.adengl.2016.01.015" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016000184?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731015003890?idApp=UINPBA000044" "url" => "/00017310/0000010700000003/v1_201603300136/S0001731015003890/v1_201603300136/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219016000160" "issn" => "15782190" "doi" => "10.1016/j.adengl.2015.05.024" "estado" => "S300" "fechaPublicacion" => "2016-04-01" "aid" => "1198" "copyright" => "AEDV" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Actas Dermosifiliogr. 2016;107:247-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 930 "formatos" => array:3 [ "EPUB" => 39 "HTML" => 479 "PDF" => 412 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Resident's Forum</span>" "titulo" => "RF - Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Treatment Update" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "247" "paginaFinal" => "248" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "FR - Síndrome de Stevens-Johnson y necrólisis epidérmica tóxica. Actualización en el manejo terapéutico" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. de Quintana-Sancho, M. Rubio-Lombraña, O. Guergue Díaz-de-Cerio, A. Barrutia-Borque" "autores" => array:4 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "de Quintana-Sancho" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Rubio-Lombraña" ] 2 => array:2 [ "nombre" => "O." "apellidos" => "Guergue Díaz-de-Cerio" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Barrutia-Borque" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731015002677" "doi" => "10.1016/j.ad.2015.05.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731015002677?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016000160?idApp=UINPBA000044" "url" => "/15782190/0000010700000003/v2_201704010117/S1578219016000160/v2_201704010117/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219016000196" "issn" => "15782190" "doi" => "10.1016/j.adengl.2015.04.022" "estado" => "S300" "fechaPublicacion" => "2016-04-01" "aid" => "1253" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2016;107:243-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 981 "formatos" => array:3 [ "EPUB" => 46 "HTML" => 735 "PDF" => 200 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case for Diagnosis</span>" "titulo" => "New-Onset Mass in an Immunosuppressed Patient" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "243" "paginaFinal" => "244" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lesión tumoral de reciente aparición en paciente inmunodeprimido" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 747 "Ancho" => 995 "Tamanyo" => 136539 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I. Vázquez-Osorio, M. Pereiro, J. Toribio" "autores" => array:3 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "Vázquez-Osorio" ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Pereiro" "sufijo" => "Jr." ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Toribio" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731015003907" "doi" => "10.1016/j.ad.2015.04.021" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731015003907?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016000196?idApp=UINPBA000044" "url" => "/15782190/0000010700000003/v2_201704010117/S1578219016000196/v2_201704010117/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case for Diagnosis</span>" "titulo" => "Lobulated Lesions on the Fingers" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "245" "paginaFinal" => "246" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Toro-Montecinos, A. Plana-Pla, L. Barboza-Guadagnini, C. Rodriguez-Caruncho" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Toro-Montecinos" "email" => array:1 [ 0 => "toromigueli@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Plana-Pla" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Barboza-Guadagnini" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Rodriguez-Caruncho" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, España" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lesiones lobuladas en los dedos de la mano" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 833 "Ancho" => 1178 "Tamanyo" => 112509 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">The patient was a 5-year-old girl with no history of interest who came to the clinic with swollen lesions on the dorsum of the fingers of her right hand. Some were congenital and others had appeared later. The lesions sometimes increased in volume, took on a violaceous color, and became painful.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed the presence of lobulated lesions on the dorsum of the second, third, and fourth fingers that were flesh-colored and easily compressed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). They were not painful, and the local temperature was not increased.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">An incisional biopsy of one of the lesions was performed. Analysis of the specimen revealed dilated vascular structures with irregular edges in the dermis; these structures were covered with a row of endothelial cells and contained eosinophilic material (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Additional Tests</span><p id="par0020" class="elsevierStylePara elsevierViewall">Doppler ultrasound and magnetic resonance were also ordered. Doppler ultrasound revealed the presence of anechoic structures separated by thick septa (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Magnetic resonance revealed the presence of a multilocular cystic mass that was hypointense in T1-weighted sequences and hyperintense in T2-weighted sequences.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">What is your diagnosis?</span></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Diagnosis</span><p id="par0030" class="elsevierStylePara elsevierViewall">Lymphatic malformation.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical Course and Treatment</span><p id="par0035" class="elsevierStylePara elsevierViewall">We decided to start sclerotherapy. Aspiration of the lesions yielded lymphatic fluid. Subsequent intralesional infiltrations of doxycycline led to a partial response.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Comment</span><p id="par0040" class="elsevierStylePara elsevierViewall">Lymphatic malformations are abnormalities of the lymphatic system that comprise abnormal lymphatic vessels and cystic structures that vary in size and shape.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Several classifications are used, the most common being that which divides malformations into diffuse and localized and, depending on the size of the cyst, into macrocystic, microcystic, and combined forms.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The case we report is difficult to classify. However, given the size of most of the cystic spaces (>2 <span class="elsevierStyleHsp" style=""></span>cc), the findings could be considered localized macrocystic malformation.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Macrocystic lymphatic malformations are present at birth in up to 50% of cases and rarely appear in adulthood. They manifest as solitary findings or, less commonly, as findings in the context of complex malformations.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The lesions usually appear on the neck or axillas, although they are occasionally found in the mediastinum, retroperitoneum, and pelvic region. They rarely appear on the upper extremities.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Clinically, they manifest as lobulated swellings that are easily compressed and do not adhere to deeper planes.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Doppler ultrasound and magnetic resonance can help to guide diagnosis. Doppler ultrasound reveals multilocular cystic structures separated by septa of varying thicknesses that are not visible on Doppler ultrasound. Magnetic resonance, which proves very useful for delimiting the lesion, reveals a multilocular cystic mass that is characteristically hypointense in T1-weighted sequences and hyperintense in T2-weighted sequences.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Histology reveals dermal or subcutaneous lesions comprising dilated vascular spaces, whose opening is defined by a line of flattened endothelial cells that stain positive for podoplanin, Lyve-1, and Prox-1.</p><p id="par0070" class="elsevierStylePara elsevierViewall">As for progress, the lesions tend to remain stable over time, and spontaneous regression is uncommon. The lesions may be complicated by inflammation, intracystic hemorrhage, or compression of neighboring structures,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> which is a potentially severe complication in lesions in the neck or mediastinum.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The differential diagnosis includes venous or arteriovenous malformations, hemangiomas, and lipomatous, fibrous, or mesenchymal soft tissue tumors.</p><p id="par0080" class="elsevierStylePara elsevierViewall">No protocols have been established for the treatment of this type of lesion, although laser therapy, radiation therapy, and sclerotherapy can be used. Sclerotherapy is the best option. The sclerosing agents used include hypertonic saline, lipiodol, bleomycin, and doxycycline, and results are variable.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Surgery is complex and is usually reserved as a complement to the other approaches.</p><p id="par0085" class="elsevierStylePara elsevierViewall">We report this case because of its unusual location and clinical presentation.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of Interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Histopathology" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Additional Tests" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Diagnosis" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Clinical Course and Treatment" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Comment" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of Interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Toro-Montecinos M, Plana-Pla A, Barboza-Guadagnini L, Rodriguez-Caruncho C. Lesiones lobuladas en los dedos de la mano. Actas Dermosifiliogr. 2016;107:245–246.</p>" ] ] "multimedia" => array:3 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 833 "Ancho" => 1034 "Tamanyo" => 121183 ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 636 "Ancho" => 1667 "Tamanyo" => 311419 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Hematoxylin-eosin ×20. B, Hematoxylin-eosin ×100.</p>" ] ] 2 => array:6 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 833 "Ancho" => 1178 "Tamanyo" => 112509 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Malformations lymphatiques kystiques" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Wierzbicka" 1 => "D. Herbreteau" 2 => "M. Robert" 3 => "G. Lorette" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Dermatol Venereol" "fecha" => "2006" "volumen" => "133" "paginaInicial" => "597" "paginaFinal" => "601" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16885857" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cystic lymphangioma with special reference to rare sites" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.K. Pandit" 1 => "K.N. Rattan" 2 => "S. Budhiraja" 3 => "R.S. Solanki" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Indian J Pediatr" "fecha" => "2000" "volumen" => "67" "paginaInicial" => "339" "paginaFinal" => "341" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10885205" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The importance of magnetic resonance imaging in the diagnosis and treatment of diffuse lymphangioma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Sermon" 1 => "J.A. Gruwez" 2 => "L. Lateur" 3 => "I. de Wever" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acta Chir Belg" "fecha" => "1999" "volumen" => "99" "paginaInicial" => "230" "paginaFinal" => "235" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10582073" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lymphatic malformations: Diagnosis and management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.G. Elluru" 1 => "K. Balakrishnan" 2 => "H.M. Padua" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.sempedsurg.2014.07.002" "Revista" => array:6 [ "tituloSerie" => "Semin Pediatr Surg" "fecha" => "2014" "volumen" => "23" "paginaInicial" => "178" "paginaFinal" => "185" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25241095" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lymphatic malformations: Review of current treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.A. Perkins" 1 => "S.C. Manning" 2 => "R.M. Tempero" 3 => "M.J. Cunningham" 4 => "J.L. Edmonds Jr." 5 => "F.A. Hoffer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.otohns.2010.02.026" "Revista" => array:6 [ "tituloSerie" => "Otolaryngol Head Neck Surg" "fecha" => "2010" "volumen" => "142" "paginaInicial" => "795" "paginaFinal" => "803" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20493348" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010700000003/v2_201704010117/S1578219016000184/v2_201704010117/en/main.assets" "Apartado" => array:4 [ "identificador" => "6154" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case for Diagnosis" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010700000003/v2_201704010117/S1578219016000184/v2_201704010117/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016000184?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 22 | 5 | 27 |
| 2024 Octubre | 222 | 40 | 262 |
| 2024 Septiembre | 150 | 24 | 174 |
| 2024 Agosto | 210 | 63 | 273 |
| 2024 Julio | 168 | 29 | 197 |
| 2024 Junio | 185 | 33 | 218 |
| 2024 Mayo | 162 | 36 | 198 |
| 2024 Abril | 150 | 22 | 172 |
| 2024 Marzo | 124 | 36 | 160 |
| 2024 Febrero | 112 | 33 | 145 |
| 2024 Enero | 139 | 33 | 172 |
| 2023 Diciembre | 107 | 19 | 126 |
| 2023 Noviembre | 146 | 28 | 174 |
| 2023 Octubre | 140 | 25 | 165 |
| 2023 Septiembre | 101 | 31 | 132 |
| 2023 Agosto | 76 | 20 | 96 |
| 2023 Julio | 125 | 34 | 159 |
| 2023 Junio | 86 | 19 | 105 |
| 2023 Mayo | 149 | 19 | 168 |
| 2023 Abril | 250 | 24 | 274 |
| 2023 Marzo | 244 | 27 | 271 |
| 2023 Febrero | 233 | 28 | 261 |
| 2023 Enero | 212 | 37 | 249 |
| 2022 Diciembre | 138 | 51 | 189 |
| 2022 Noviembre | 120 | 27 | 147 |
| 2022 Octubre | 132 | 30 | 162 |
| 2022 Septiembre | 166 | 32 | 198 |
| 2022 Agosto | 106 | 36 | 142 |
| 2022 Julio | 122 | 32 | 154 |
| 2022 Junio | 169 | 31 | 200 |
| 2022 Mayo | 154 | 37 | 191 |
| 2022 Abril | 155 | 19 | 174 |
| 2022 Marzo | 77 | 33 | 110 |
| 2022 Febrero | 128 | 35 | 163 |
| 2022 Enero | 88 | 35 | 123 |
| 2021 Diciembre | 50 | 35 | 85 |
| 2021 Noviembre | 52 | 36 | 88 |
| 2021 Octubre | 53 | 46 | 99 |
| 2021 Septiembre | 40 | 37 | 77 |
| 2021 Agosto | 38 | 31 | 69 |
| 2021 Julio | 42 | 21 | 63 |
| 2021 Junio | 29 | 34 | 63 |
| 2021 Mayo | 29 | 26 | 55 |
| 2021 Abril | 129 | 71 | 200 |
| 2021 Marzo | 69 | 38 | 107 |
| 2021 Febrero | 67 | 29 | 96 |
| 2021 Enero | 38 | 16 | 54 |
| 2020 Diciembre | 37 | 16 | 53 |
| 2020 Noviembre | 22 | 20 | 42 |
| 2020 Octubre | 22 | 16 | 38 |
| 2020 Septiembre | 36 | 7 | 43 |
| 2020 Agosto | 31 | 18 | 49 |
| 2020 Julio | 16 | 13 | 29 |
| 2020 Junio | 35 | 28 | 63 |
| 2020 Mayo | 20 | 21 | 41 |
| 2020 Abril | 24 | 13 | 37 |
| 2020 Marzo | 34 | 21 | 55 |
| 2020 Febrero | 4 | 0 | 4 |
| 2020 Enero | 3 | 1 | 4 |
| 2019 Diciembre | 4 | 1 | 5 |
| 2019 Noviembre | 4 | 2 | 6 |
| 2019 Octubre | 0 | 1 | 1 |
| 2019 Septiembre | 0 | 2 | 2 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 4 | 0 | 4 |
| 2019 Junio | 4 | 0 | 4 |
| 2019 Mayo | 4 | 12 | 16 |
| 2019 Abril | 3 | 1 | 4 |
| 2019 Marzo | 2 | 3 | 5 |
| 2019 Febrero | 2 | 0 | 2 |
| 2019 Enero | 3 | 0 | 3 |
| 2018 Diciembre | 5 | 0 | 5 |
| 2018 Noviembre | 12 | 0 | 12 |
| 2018 Octubre | 58 | 0 | 58 |
| 2018 Septiembre | 6 | 0 | 6 |
| 2018 Abril | 0 | 1 | 1 |
| 2018 Marzo | 0 | 2 | 2 |
| 2018 Febrero | 29 | 4 | 33 |
| 2018 Enero | 84 | 7 | 91 |
| 2017 Diciembre | 29 | 24 | 53 |
| 2017 Noviembre | 20 | 44 | 64 |
| 2017 Octubre | 19 | 35 | 54 |
| 2017 Septiembre | 19 | 32 | 51 |
| 2017 Agosto | 25 | 25 | 50 |
| 2017 Julio | 11 | 22 | 33 |
| 2017 Junio | 32 | 6 | 38 |
| 2017 Mayo | 33 | 7 | 40 |
| 2017 Abril | 19 | 13 | 32 |
| 2017 Marzo | 13 | 6 | 19 |
| 2017 Febrero | 17 | 5 | 22 |
| 2017 Enero | 14 | 3 | 17 |
| 2016 Diciembre | 22 | 9 | 31 |
| 2016 Noviembre | 21 | 11 | 32 |
| 2016 Octubre | 25 | 24 | 49 |
| 2016 Agosto | 1 | 1 | 2 |
| 2016 Mayo | 0 | 1 | 1 |
Mostrar todo
